Glenn Anthony Benavidez Jr.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1300 East River Rd.
Belen, NM 87002-8706

Phone

(505) 312-0040

NPI assigned

Feb 3, 2021

Last updated

Feb 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Heart & Soul of NM, Inc

  • Community/Behavioral Health Agency
  • Belen, NM
  • NPI 1922504117
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1871184671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292",
            "city": "TOME",
            "state": "NM",
            "postal_code": "870600292",
            "telephone_number": "505-312-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 EAST RIVER RD.",
            "city": "BELEN",
            "state": "NM",
            "postal_code": "870028706",
            "telephone_number": "505-312-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENAVIDEZ",
        "first_name": "GLENN",
        "middle_name": "ANTHONY",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Rae Bejcek
• Belen Consolidated Schools
• Belen Family Dentistry LLC
• Belen Meadows Healthcare and Rehabilitation Center, LLC (Belen Meadows Healthcare and Rehabilitation Center)
• Carla Belot, SLP
• Carmen Benson, FNP-C, RN
• Melinda Dawn Bernal, OTR/L
• Besito Mental Healthcare of New Mexico, LLC
• Best Life Counseling Services
• Adrianne Blair

• Community Health Worker in Belen, NM
• Providers in Belen, NM by specialty
• Community Health Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.